Application of High-Resolution Ultrasound on Diagnosing Diabetic Peripheral Neuropathy

Huang, Hailun; Wu, Shan

doi:10.2147/dmso.s292991

Cited by 22 publications

(25 citation statements)

References 74 publications

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“…13,14 However, the reasons for nerve swelling in diabetes are yet to be determined and the ultrasound appearance in Supplementary Figure S2 does not particularly demonstrate features of oedema. 15 While an association between serum potassium and nerve CSA was not observed in this study, our participants were not hyperkalaemic and had less severe kidney dysfunction than those recruited in a previous study of end-stage kidney disease patients. 7 Presumably, this resulted in less pronounced effects on nerve structure than would occur in patients on dialysis.…”

Section: Discussioncontrasting

confidence: 58%

“…The altered osmotic gradients that occur in diabetes, as a result of the conversion of glucose to sorbitol and sodium‐potassium pump dysfunction, may also contribute to the greater enlargement in the DKD group via intracellular sodium retention 13,14 . However, the reasons for nerve swelling in diabetes are yet to be determined and the ultrasound appearance in Supplementary Figure S2 does not particularly demonstrate features of oedema 15 . While an association between serum potassium and nerve CSA was not observed in this study, our participants were not hyperkalaemic and had less severe kidney dysfunction than those recruited in a previous study of end‐stage kidney disease patients 7 .…”

Section: Discussionmentioning

confidence: 99%

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Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

et al. 2022

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Introduction/Aims: Sonographic alterations of peripheral nerves in pre-dialytic kidney disease are yet to be determined. We aimed to assess peripheral nerve crosssectional area (CSA) and intraneural blood flow in patients with pre-dialytic chronic kidney disease (CKD) and diabetic kidney disease (DKD).Methods: Subjects with CKD (n = 20) or DKD (n = 20) underwent ultrasound to assess CSA of the median and tibial nerves as well as intraneural blood flow of the median nerve. Blood flow was quantified using maximum perfusion intensity. Neuropathy was assessed using the Total Neuropathy Score. A 6-m timed walk test was also performed. Healthy controls (n = 28) were recruited for comparison. Results:The DKD group had more severe neuropathy (p = .024), larger tibial nerve CSA (p = .002) and greater median nerve blood flow than the CKD group (p = .023).Blood flow correlated with serum potassium in disease groups (r = 0.652, p = .022).Disease groups had larger tibial nerve CSA than controls (p < .05). No blood flow was detected in controls. Tibial nerve enlargement was associated with slower maximal walking speeds in disease groups (r = À0.389, p = .021).Discussion: Subjects with DKD demonstrated enlarged tibial nerve CSA and increased median nerve blood flow compared to those with CKD. Elevations in serum potassium were associated with increased blood flow. Sonographic alterations were detectable in pre-dialytic kidney disease compared to controls, highlighting the utility of ultrasound in the assessment of nerve pathology in these patient groups.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

et al. 2022

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“…We agree with Dr. Hernandez Fustes that the techniques he highlights, high resolution ultrasound (HRU) and pain-related evoked potentials (PREP), may offer additional options for diagnosis of diabetic neuropathy. There is a striking concordance amongst recent HRU studies in diabetic patients that nerve cross-sectional area (CSA) is increased compared to the nerves of control subjects [ 2 ]. Reference values have been established [ 3 ] and this technique offers the additional advantage of allowing measurement of nerve blood flow by Doppler shift [ 4 ], changes in which have been implicated in the pathogenesis of diabetic neuropathy [ 5 ].…”

supporting

confidence: 53%

Lost in Translation? Measuring Diabetic Neuropathy in Humans and Animals (Diabetes Metab J 2021;45:27-42)

2021

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“…The diagnostic sensitivity of tibial nerve width is only 52.27%, and the specificity is 61.36%. The tibial nerve and its branches below the ankle joint also innervate the skin and plantar muscles, and plantar paresthesia is an early manifestation of DNP (37)(38)(39). MNSI-PE evaluates nerve cell function and nerve conduction damage through ankle reflexes, toe vibration, and light touch sensation.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of the ultrasound characteristics of the tibial nerve in patients with type 2 diabetic peripheral neuropathy

et al. 2021

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Background: Ultrasound is a promising imaging examination for type 2 diabetic peripheral neuropathy (DPN). This study aimed to explore the risk factors of ultrasound diagnostic characteristics in the tibial nerves of patients with type 2 DPN. Methods:The Michigan Neuropathy Screening Instrument (MNSI) was used for neuropathy evaluation, and 520 patients with type 2 diabetes were divided into a DPN group and non-DPN (NDPN) group with 2 points as the cut-off value. The two groups were matched at a ratio of 1:1 according to age, BMI, calf circumference, and gender, resulting in 44 matched pairs. The dependent variable was type 2 DPN and the concomitant variables were the width, thickness, cross-sectional area, and unclear honeycomb-like structure of the tibial nerve. A 1:1 matched conditional logistic regression model was established to analyze which ultrasound diagnostic characteristics of the tibial nerve were risk factors for type 2 DPN.Results: The thickness (OR =5.176, P=0.043) and cross-sectional area (OR =1.659, P=0.030) of the tibial nerve were risk factors for the diagnosis of DPN, while the width and unclear honeycomb-like structure of the nerve were not (P>0.05). In the diagnosis of DPN, the area under the receiver operating characteristic (ROC) curve of the cross-sectional area of the tibial nerve was 0.747, and the sensitivity, specificity, positive predictive value, and negative predictive value were 61.36%, 95.45%, 93.10%, and 71.20%, respectively.The area under the ROC curve of tibial nerve thickness was 0.867, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.82%, 90.91%, 90.00%, and 83.30%, respectively.The area under the ROC curve of thickness was larger than that of cross-sectional area of the tibial nerve (z statistic =1.800, P=0.07). Conclusions:The thickness and cross-sectional area of the tibial nerve measured by ultrasound are risk factors for type 2 DPN. The diagnostic sensitivity of the thickness is higher than the cross-sectional area, while the diagnostic specificity of the cross-sectional area is higher than the thickness.

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Application of High-Resolution Ultrasound on Diagnosing Diabetic Peripheral Neuropathy

Cited by 22 publications

References 74 publications

Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

Lost in Translation? Measuring Diabetic Neuropathy in Humans and Animals (Diabetes Metab J 2021;45:27-42)

Retrospective study of the ultrasound characteristics of the tibial nerve in patients with type 2 diabetic peripheral neuropathy

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